State applies for Medicaid innovation project

The state is moving forward with a plan to reorganize Medicaid services for certain individuals with mental health and substance use disorders.

The Alaska Department of Health and Social Services applied for a waiver from the federal Center for Medicare and Medicaid Services, known as a Section 1115 waiver, to create a Behavioral Health Demonstration project on Feb. 14. Within the project, Medicaid recipients who are children, teenagers and their parents or caretakers with or at risk of mental health and substance use disorders, transitional age youth and adults with acute mental health needs and teenagers and adults with substance use disorders would receive a specific set of services.

The overall goal is to help improve health outcomes and ultimately reduce their use of acute health care services, thus reducing costs, according to the DHSS’ application.

“Because behavioral health challenges often stem from childhood trauma and other adverse experiences and have downstream effects on entire families that translate to higher costs associated with subsequent acute care and chronic health needs, this proposal also aims to establish networks of support for individuals and family members,” the application states.

The application is called a waiver because it allows the state to waive the Medicaid rules for specific populations, said Gennifer Moreau-Johnson, the project coordinator with the DHSS.

“We can’t parse out services for one population versus another,” she said. “What we’re saying is we have identified populations (who) end up being acute consumers. What we’re saying is if we can target these populations to divert them from acute care … we think we’re going to save money and drive down for acute care. We’re calling out a service array.”

The state completed a study in 2013 detailing the extent and impact of adverse childhood experiences as a factor of behavioral health risk. The study correlates adverse childhood experiences to a host of later health issues, from lung cancer to low income, and can be connected to the presence of substance abuse or mental illness in a home.

The demonstration project is designed to develop a system of care complete with data to prove its effectiveness and provide better care for more people at lower cost, a mandate known as “the triple aim” in health care.

The state would set up interventions and screenings to help meet the needs of the patients fitting those three populations to help prevent worse health outcomes in the future. Some of those options include universal screenings for mental health and substance use, community-based outpatient services, acute intensive services for children and teenagers in crisis and community and recovery support services to promote stability. It will also include medication-assisted treatment for teenagers and adults with substance use disorders.

Fundamentally, the goal is to spot these patients earlier and intervene before they end up going into crisis. The Medicaid law clause allowing states to do this refers to innovation ideas, so the state is still shaping exactly how it will look, Moreau-Johnson said. She said the department expected the commenting process and final revisions to take about a year after the application was submitted.

“The application is really going back to the 1115 Section, which is really an innovative idea,” she said. “This is the biggest level, first run at this project … All these things really take a lot of ironing out. We’ll be negotiating with CMS.”

Some of the evaluating data points for success include starting of alcohol or drug dependence treatment, diabetes screenings for people with schizophrenia or bipolar disorder taking antipsychotic medications and usage of high dosages of opioids in people without cancer, among a variety of other measures. The data will be gathered and analyzed by an administrative services organization contracted by the state, Moreau-Johnson said. The exact services the organization will provide are still being decided, she said.

The application is available for public comment until March 17. Comments can be submitted on CMS’ website.

Reach Elizabeth Earl at eearl@peninsulaclarion.com.

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